Appendix 1: High-level Overview Note – COVID-19 Evaluation: Nursing Homes Insights Workshop, 3 June 2025
The session was attended by the Chair and panel members of the independent COVID-19 Evaluation; members directly involved in the 2020 Expert Panel Report on nursing homes and related implementation reports, and independent academics and researchers in the broad field of long-term residential care for older persons.
The workshop context was the Terms of Reference for the independent COVID-19 Evaluation in relation to a specific module regarding the response to COVID-19 in long-term residential care facilities for older persons, and the need to build upon existing reports, progress, outputs and research. The purpose of the workshop was to gain an initial sense of the research landscape and related work to date.
At the event, the work carried out for the 2020 Expert Panel Report and implementation reports was outlined, including context, Terms of Reference, approach (including consultation), and challenges. The willingness of the different sectors to engage and work together was emphasised, as was the fact that much was achieved, and that this needed be recognised. Comprehensive work on a framework for Safe Nurse Staffing and Skills mix in Long-term Residential Settings for Older People, an important aspect of the 2020 Report’s recommendations, was outlined. This included a proposed system based on distinct care needs of residents. Results of a staff survey were also discussed.
The purpose of the open discussion format was not to reach a consensus but to have a frank and considered exchange of views from a range of diverse perspectives. These diverse views included the limitations of frameworks, staff turnover and education and training needs, the meaning of person-centred care, and the value and necessity of advocacy. Shortcomings in information integration were also highlighted.
Specific participants outlined their personal views. These included that the COVID-19 response internally and externally was very poor in nursing homes, particularly in the early stages, with multiple problems highlighted. A participant also suggested that while the Terms of Reference for the COVID-19 Evaluation is rooted in the future, the Evaluation needs to thoroughly evaluate the systemic and other failures that occurred in the sector to adequately plan for the future. Wider issues relating to a system of neglect were also highlighted by one participant, including the area being chronically under-researched, lacking a coherent national policy framework and underfunded, with significant investment required. One of the participants also noted that nursing homes present complex issues around human rights, which are not simple to address.
Overall staffing was flagged as an issue, with terms and conditions a contributing factor. It was suggested that waiting list for home care, and the fact that the proportion of people in nursing homes is returning to pre-COVID times, point to a lack of wider resources and care options. It was further noted that ownership is moving towards private equity companies, with views expressed regarding a lack of open data making monitoring difficult. Finally, the need for clarity around clinical governance in nursing homes was expressed.